It may appear that the vision industry has been remarkably silent on the effects of health care reform on the provision of benefits, at least when compared to their counterparts in the dental industry.

But vision care providers worked quietly behind the scenes, aligning themselves with the much larger, more vocal, dental industry.

"Our push relative to being heard on health care reform was to be in tandem with the dental industry," says Al Schubert, vice president, managed care and health policy with VSP. "And the dental industry is very organized, they have a very large, vocal and active association, and we were side by side with them in many of the health care reform efforts."

The National Association of Vision Care Plans lobbied to have vision benefit companies provide services in the exchanges, but stand-alone vision plans have ultimately been excluded from participating in the exchanges.

While the reform legislation will have little effect on current business opportunity to expand their business through the exchanges, says Richard Sanchez, president of NAVCP, and CEO and founder of Advantica Eyecare."

Health care reform has passed and it's a disappointment for us because we feel vision plans provide very good access to lots of people like it does today, so why not the uninsured?" he says. "We continue to have discussions on Capitol Hill to present data, and we'll see where that goes."

Pat Huot, director of managed vision care at Transitions Optical, maintains that health care reform's emphasis on wellness and preventive care is a good thing for the industry. "No matter what the final details are, we'll all be held to more accountability for our health care and preventive health care," he says.

Apart from health care reform, the vision industry has continued to improve lens technology and benefits plans are stepping up to provide discounts or partial coverage for improved technologies.

Polycarbonite lenses, often referred to as childproof because they don't shatter, are growing in popularity and "more and more vision benefit companies [are] including coverage for their members who are under 18 or 19 years old as part of the benefit," says Sanchez. "Which makes sense, especially if you have a family."

More plans are also including progressive lenses, also known as bifocals, says Sanchez. Traditionally, progressive lenses would have been included as an upgrade or not covered at all, but "more and more plans are including progressive lenses as part of their benefit."

And with changing demographics - an aging population and employees who are staying in the workforce longer - the need for technologies such as progressive lenses will only increase.

"That person who's 60 only has about a third the amount of light entering their eye as someone who's 20," says Huot. "So products like anti-reflective coatings and photochromics [which help protect eyes from UV damage], that help regulate that light and reduce glare, really make a big difference the older we get."

He's noticed carriers being more open to including premium lens options, such as photochromics, in their plans. According to Transitions research, 60% "of full-time employees say they'd be more likely to enroll or re-enroll in their vision plan if it included premium lens options," he says.

Retinal imaging is "really starting to take off," according to Schubert. It's technology that can take a detailed image of the back of the retina. It can detect micro aneurysms in the eye, which can indicate the onset of diabetes years before other symptoms occur.

"Not only does it provide a record, but the image can be e-mailed so primary care physicians can interact with optometrists and ophthalmologists, and see what they're seeing," says Schubert, adding that retinal imaging is typically part of a comprehensive eye exam, but because there's a cost involved, it's often offered as a buy-up.

Another plan innovation noted by Huot is a sort of satisfaction guarantee "where a plan will allow members to try technology for a period of time, risk-free," he says.

Historically, vision benefits have been offered as an employer-paid benefit. But as employers attempt to rein in costs, vision benefits are increasingly being offered on a voluntary basis.

"Today, the majority of new business we're selling is coming to us on a contributory basis," says Schubert. "In some cases it's 100% contributory; in other cases the employers are offering the eye exam as a core benefit for diagnostic, prevention and wellness reasons, and then they're allowing the materials - eyewear, contact lenses - to be the voluntary component."

But Sanchez says there are companies that still provide vision coverage and other ancillary benefits as part of their paid-for medical plan.

"There has been a trend, especially in 2009 when we were all faced with the economy issue, where companies that had traditional employer-paid coverage transitioned to employee-paid coverage," he says. "But there are still some companies in some sectors where those benefits are paid for either totally or partially."

ROI on vision

Helping employers determine their return on investment for their vision plans just got a little easier thanks to a new tool called the Healthy Sight Calculator.

The calculator pulls data from a number of established sources, such as the American Diabetes Association, the American Heart Association and the Centers for Disease Control and Prevention, and provides employers with a snapshot of the health of their employee population.

Based on the profile of the workplace, the calculator will determine roughly the percentage of employees who are prediabetic, have diabetes, are at risk for hypertension or have hypertension, as well as the approximate percentage of employees who have glaucoma, cataracts and macular degeneration.

"It allows the broker to put a return on investment for the benefit manager," says Pat Huot, director of managed vision care with Transitions Optical. "They can sit down with an employer and say, 'If you were to put in a premium vision plan, say one that is $80 per member per year, here's what you can expect for the cost in terms of your ROI from a medical cost perspective, as well as a productivity perspective.'"

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